The Health Care Safety Net in South Carolina - State Coverage

Site Visit Report

The Health Care SafetyNet in South Carolina:A Test of Tenacity

February 17–19, 2004 / South Carolina

NHPF Site Visit Report February 17–19, 2004 / South Carolina

Site Visit ManagersJennifer Ryan / Randy Desonia

Administrative CoordinatorMarcia Howard

National Health Policy Forum2131 K Street, NW, Suite 500Washington, DC 20037

202/872-1390202/862-9837 [fax][email protected] [e-mail]www.nhpf.org [web site]

Judith Miller Jones – DirectorSally Coberly – Deputy DirectorMichele Black – Publications Director

NHPF is a nonpartisan education andinformation exchange for federalhealth policymakers.

CONTENTS

Acknowledgments .............................................................. ii

Background .........................................................................1

Program ...............................................................................3

Impressions ..........................................................................5

Concerns for the Future ....................................................10

Agenda ..............................................................................11

Federal Participants ...........................................................17

Biographical Sketches —

Speakers ...........................................................................19

Federal Participants .........................................................25

ACKNOWLEDGMENTS

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This site visit, “The Health Care Safety Net in South Carolina: A Testof Tenacity,” represented a long-awaited return to the South for theNational Health Policy Forum. The value of the lesson “when you’veseen one state, you’ve seen one state” was illustrated throughout ourtime in the Charleston area. Made possible through generous supportfrom the Forum’s core funders, the W. K. Kellogg Foundation andthe Robert Wood Johnson Foundation, with additional funding fromthe David and Lucile Packard Foundation and the John D. andCatherine T. MacArthur Foundation, the two-day tour and study ofSouth Carolina’s health care system provided a number of valuablelessons for 20 site visitors and five NHPF staff.

We experienced the famous “southern hospitality” throughout the sitevisit, but special recognition and thanks go to several individuals whohosted us in their facilities on Johns Island and in North Charleston.Thanks to Nancy Bracken and Genevieve Jones, MD, and their stafffor providing an excellent tour of the Sea Island Medical Center. Wewould also like to thank Sister Mary Joseph Ritter and her staff for sograciously hosting us at the Our Lady of Mercy Outreach. Jakki Jeffersonand Annette Maranville were particularly helpful to us in our planningfor the visit. The wonderful luncheon that was provided by the RuralMission will stay in all of our memories as well. Finally, we are grate-ful for the commentary provided by Alicia Carvajal and DeborahHarnish during our tour of a local migrant farm worker camp.

Our visit to North Charleston was also rewarding. We are grateful toMaggie Michael and Patty Fournier for hosting us at the MedicalUniversity of South Carolina (MUSC) Children’s Care site and fortheir assistance in planning for the visit. We also appreciated the timeMatt Davis, MD, gave to us in demonstrating the electronic medicalrecord system.

We also want to thank the many distinguished speakers who so gener-ously traveled to Charleston from around South Carolina and beyondto participate in our program: Pete Bailey, Dave Murday, Robby Kerr,Kathy Schwarting, David Hayden, Pete Bowman, Lathran Woodard,Ann Lewis, Nela Gibbons, Ken Trogdon, and Hugh Greeley. Severalpeople from the South Carolina Department of Health and HumanServices were helpful to us in our preparation for the site visit, includ-ing Robby Kerr, Gwen Power, Susan Bowling, Nela Gibbons, Pete Bailey,Dennis Dickerson, Diane Tester, and Helen Thomas.

As always, the thoughtful insights, questions, and discussion pointsraised by our federal participants were integral to the success of thesite visit and help us to continuously improve the timeliness and valueof our programming.

NHPF Site Visit Report


The Health Care Safety Net inSouth Carolina: A Test of Tenacity

BACKGROUNDThe state of South Carolina has a rich and complex history that hasmade the creation of a site visit there fascinating. The make-up andsignificance of the health care safety net is a result of the economic,cultural, and political environment that has been exacerbated by therecent budget crisis. South Carolina’s economy has evolved over time—shifting focus from agriculture to industry to tourism—leaving in itswake an unemployment rate of 7 percent and an average per capitaincome of less than $25,000. Although the state ranks low in annualincome, it ranks high in geographic and cultural diversity: rural areasmake up 40 percent of the state, one-third of the population is AfricanAmerican, and the Latino population is growing exponentially. While,in many ways representative of its sister states of the South, SouthCarolina’s approach to its health care system is often unique.

Medicaid and SCHIP

Reflecting its relative poverty and smaller tax base, South Carolina’sMedicaid and State Children’s Health Insurance Program (SCHIP)eligibility levels have not increased at the same pace as those of statesin other regions of the country. Its SCHIP Medicaid expansion pro-vides coverage for children with incomes up to 150 percent of thefederal poverty level (FPL) ($22,890 for a family of three in 2003),but Medicaid coverage for adults is limited to 50 percent of the FPL($4,490 for an individual).

As in most other states, the state’s budget crisis has begun to take itstoll on public health programs. South Carolina has curtailed outreachefforts in hopes of curbing the enrollment increases that resulted fromthe implementation of SCHIP; and last year the state stopped its prac-tice of providing “passive renewals” of eligibility, meaning that indi-viduals are no longer assumed to be eligible until they report a changeof income. This change resulted in a caseload decline of more than 30percent, or 30,000 individuals. Further eligibility and benefits cutsare not anticipated, nor are reductions in provider payments, but alloptions remain on the table in the state legislature.


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South Carolina used the federal matching percentage increases allo-cated last year to fully fund the Medicaid program, but that money isexpected to run out this summer, with no additional funds availableto begin the next state fiscal year.

It is notable that the state has not yet used managed care to containcosts in Medicaid, although the state legislature has repeatedly con-sidered proposals to do so in the face of strong resistance from theprovider community. The state’s private insurance market remainsalmost entirely fee-for-service, with only 7 percent managed care pen-etration. While several managed care organizations have plans to en-ter the South Carolina market, only one has done so thus far.

Safety Net Dynamics

Because of limited availability of public and private health insurancecoverage, the “safety net” in South Carolina plays a vital role in pro-viding access to health care for a large portion of the population. Abroad network of community health centers (CHCs), hospital sys-tems, and community and faith-based organizations make up an in-tricate patchwork of service delivery for the uninsured, the undocu-mented, and other low-income populations.

South Carolina boasts at least one hospital in all but three countiesacross the state. Particularly in many of the rural areas, these hospi-tals are struggling to compete with larger, more technologically ad-vanced and better-funded facilities that see opportunities to expandtheir catchment areas to communities with high incidences of diabe-tes, heart disease, obesity, and asthma. As a result, these larger hospi-tals attract the higher-income patients, leaving those with fewer meansand who often lack transportation to be cared for in the smaller facili-ties. South Carolina is one of only a handful of states that receivedisproportionate share hospital (DSH) funding that exceeds 12 per-cent of total Medicaid payments, and the state has made a commit-ment to ensure that DSH funds go to hospitals with high rates ofuncompensated care.

CHCs play a vital role in serving low-income populations, providingprimary care services and community-based programs at low or nocost. A mix of urban and rural, the 20 CHCs in South Carolina providehealth care services to more than 200,000 patients each year. Becauseof the small proportion of physicians who accept Medicaid patients intheir private practices, in some communities, CHCs are the only avail-able source of health care providers. In many cases, the viability of ahealth center is dependent on the availability of federal funding—earning federally qualified health center (FQHC) status—which en-sures that the center will receive Medicaid cost-based reimbursementthat often enables them to stay in business.

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Necessity, the Mother of Invention

As has become apparent across the country, the safety net has manyholes and is often frayed along the edges. In response, severalprovider-driven and other privately funded initiatives have emergedto take matters into their own hands. For example, in the late 1990s,Jack McConnell, MD, a physician and entrepreneur who retired toHilton Head Island, decided to start a health clinic called Volunteersin Medicine (VIM). The clinic, staffed by a broad network of retiredphysicians and other volunteers, provides free health care to the low-income community on the island. The concept has taken off and hasbeen replicated in several other states as part of an overall physicianvolunteerism movement.

A slightly different approach was designed by a physician who wasfrustrated with the inadequacies of the health care system. CaseyFitts, MD, a surgeon by training, spent a one-year hiatus working tosecure foundation and community funding for a program namedTri-County Project Care (TCPC). He designed the program with thegoal of moving away from a health care system in which delayedpreventive care too often results in recurring acute care episodesthat require expensive and time-consuming trips to the emergencyroom. Targeted at low-income, working adults with no other accessto health insurance, TCPC connects enrollees to a provider networkand ensures that they receive needed medical care. The programinitially relied on providers’ volunteering their services but has in-crementally increased payment rates so that providers are currentlyreimbursed at 60 percent of their costs.

South Carolina, like most other states, faces ongoing challenges inensuring access to health care for its most vulnerable citizens. Thissafety net, a fragile weaving of state and local, community and pri-vate resources, will continue to strive toward ensuring access to healthcare in a difficult fiscal environment—it is a true test of tenacity.

PROGRAMFrom February 17 through 19, 2004, a group of 20 site visit participantsand five National Health Policy Forum staff took an in-depth look atthe health care safety net in the state of South Carolina, with particularfocus on the Charleston area. The program opened on Tuesday after-noon at the headquarters hotel in the historic district. The first sessionprovided an informative overview of South Carolina’s history andpolitical context, presented by Pete Bailey and David Murday, two ofthe state’s foremost experts in health policy and research. In the sec-ond session, the state Medicaid director, Robert Kerr, provided a de-scription of the state’s Medicaid program and highlighted some of thekey policy and political issues that have been defined by the currenteconomic environment. An informal dinner followed, and the two open-ing speakers joined the group for continued conversation.


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Day two opened with a session at the hotel that brought to life theissues around serving vulnerable populations in rural areas. Repre-senting hospital systems and community health centers, the speakersdiscussed the economic challenges of operating their facilities and theimportance of federal funding in keeping their doors open.

Next, the group departed for a visit to Johns Island, which provideda significant contrast to Charleston, despite being only 15 miles away.The first stop was a tour of the Sea Island Medical Center, the island’sonly community health center. After a short tour of the facility, theSea Island staff accompanied the site visitors to a nearby location wherethey were able to continue the conversation about policy issues. There,the discussion further explored the role of the Sea Island MedicalCenter on the island as well as some of the center’s problems withservice delivery and management.

The second area the group looked at on Johns Island was the healthand social services provided by a local faith-based organization, OurLady of Mercy Community Outreach Services (the OLM Outreach).The director gave site visitors an overview of the mission and itswide range of services, including those offered through a WellnessCenter that provides primary and preventive dental care as well asprenatal care for pregnant women (who are predominantly undocu-mented immigrants and therefore not eligible for Medicaid). The grouptoured both the OLM Outreach facility and the Wellness Center andcontinued a discussion with the leadership and staff that increasedunderstanding of the ways the organization is structured and financedand some of the successes and challenges that arise when servinglow-income, uninsured families.

The visit to Johns Island included a special focus on the health condi-tions of the local migrant farm worker community, conditions thatare only exacerbated by language barriers, immigration status issues,and substandard living quarters. The group briefly toured a localmigrant camp (where workers will live next summer) that is near theOLM facility.

The final day of the site visit opened with a discussion of the overall roleof community health centers in sustaining the safety net and focused ona promising strategy for reducing health disparities illustrated byCareSouth Carolina, a health center network in the Pee Dee region ofthe state. The group then moved to an on-site visit to highlight anotherpromising effort in South Carolina, a movement to enroll children in“medical homes” designed to help ensure access to primary and pre-ventive care. Sponsored by the Medical University of South Carolina(MUSC), the Children’s Care center also utilizes an electronic medicalrecord system that is bolstering the efficiency and continuity of care.The group next heard from two representatives of the South CarolinaDepartment of Health and Human Services who provided an overviewof the Medicaid eligibility and enrollment process and highlighted some

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IMPRESSIONSof the proposed program restrictions, such as eliminating the State Children’s HealthInsurance Program (SCHIP) and implementing an active redetermination process,that have been subject to debate in light of the state budget crisis.

The final session of the site visit focused on several provider-driven initiatives thatattempt to round out the safety net in South Carolina. The group heard aboutphysician-sponsored efforts at the Volunteers in Medicine clinic in Hilton Head,pharmaceutical assistance provided to low-income individuals through Communicare,and Tri-County Project Care, a fledgling insurance program for low-income work-ing adults. The discussion provided an excellent closing to the two-day experienceof studying the innovation and difficulties of weaving together many sources ofcare in hopes of improving the overall health of the population.

IMPRESSIONS

Overall

Access to health care in South Carolina is hindered by socioeconomic factorssuch as low educational attainment and multigenerational poverty.

South Carolina has struggled with its education system, often having problemswith funding and administration. In 2000, with a high school graduation rate ofonly 56 percent, South Carolina ranked 46th out of all 50 states. More than 70percent of 18-year-olds in the state are considered “not available for college appli-cation.” These educational deficits lead to lower earning potential and increasedlikelihood of living at or near the poverty line. While South Carolina is not anextremely poor state (ranking as the 21st poorest state in 2000), it continues tosuffer from the loss of manufacturing jobs, a trend that began 20 years ago. Thestate also has a low rate of unionization and corresponding employer-sponsoredhealth coverage, combined with a limited Medicaid program. A recently releasedstate survey indicated that 19 percent of the residents of South Carolina wereuninsured at some point during the year, one of the highest rates in the nation.

Despite committed efforts by providers and program administrators, the safetynet seems to be a loosely connected patchwork.

A combination of hospitals, community health centers, public health coverageprograms, and faith-based and other community-supported efforts makes up afragile, although not entirely ineffective, safety net. The disconnects seem to beexacerbated by tensions between the executive and legislative branches of thestate government.

South Carolina relies heavily on the ability to leverage federal funding tosupport public programs.

The state’s financial structure has grown increasingly dependent on federal fund-ing sources—Medicare reimbursement, Medicaid matching funds, disproportion-ate share hospital (DSH) payments, and special earmarks secured by the state’s


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IMPRESSIONS long-serving, high-ranking members of Congress—to sustain health access andtreatment programs. On one hand, federal funding sources enable states to fi-nance programs and services that could not be provided with state dollars alone.However, dependence on these funds, which are accompanied by federal require-ments for how they can be used, can also be a barrier to tailoring programs tomeet the needs of an individual state.

Chronic diseases and conditions (diabetes, hypertension, and obesity) arepervasive, and health care providers are struggling to treat them as well as toshift the paradigm toward prevention.

These issues were evident throughout the site visit and seemed to be driven bya combination of culturally influenced eating habits and lifestyles and the lack ofusual sources of preventive care.

The rich yet troubled history of the region continues to play a role in howdifferent racial and ethnic communities interact.

While race is not blatantly an issue in policy debates, the historical divisionsbetween people have made communication and, in some cases, collaboration moredifficult. In addition, the recent influx of immigrants and corresponding growthof a Latino community has also influenced the dynamics of the health care andsocial service sectors.

Hospitals and Health Centers: Sustaining the Rural Safety Net?

Some rural health care providers are looking for ways to work together bypooling resources and sharing best practices that will enable them to competewith larger, more advanced health systems.

A question remains whether keeping small hospitals open in nearly every countyis the best thing for the community or whether resources could be better utilizedby supporting primary care expansions and quality improvement efforts. Be-cause federal funding streams generally support only acute care, these rural hos-pitals have little incentive or ability to focus on prevention efforts. Instead, anyadditional money is spent primarily on developing diagnostic capabilities andadministration. Finally, the hospitals are in dire need of capital investment toupdate and renovate facilities, most of which were built in the 1950s. Federalfunding limitations that require all monies be used exclusively for providing di-rect services seem to disregard the ongoing need for building maintenance.

Disproportionate share hospital (DSH) funding and Medicare reimbursementare essential to the survival of many hospitals, particularly those serving thisvery rural state.

More than 40 percent of South Carolina is made up of rural communities, and all butten hospitals in the state qualify for a portion of the $400 million disproportionateshare hospital (DSH) allotment, a key lifeline for many. South Carolina is one of nine

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IMPRESSIONS“high DSH” states, meaning that DSH funds exceed 12 percent of total Medicaidspending each year. Rural hospitals and health care providers are increasingly de-pendent on Medicare reimbursement and special financing sources that are intendedto assist facilities serving a large number of frail and elderly individuals.

Transportation is a persistent barrier to accessing health care services.

Many low-income families do not own a car or only have one vehicle, which theprimary wage earner needs for getting to and from work. In most areas of thestate, there is no public transportation system at all; in the areas that do have bussystems, services have often been reduced. Consequently, individuals must relyon friends and family members or on the limited services provided by somehospitals and health centers. Medicaid-funded transportation is available butcomplicated and difficult to use. Drivers can be unreliable, and the rules requirethat only the individual who has the appointment can ride in the vehicle, whichcan lead to child care difficulties.

Medicaid and the Bottom Line

As in most other states, the state budget crisis is taking its toll on the Medicaidprogram, with prescription drug costs topping the list of major fiscal pressurepoints.

While South Carolina’s legislature voted to use the entire sum of federal assis-tance provided last year to fund the Medicaid program, shortfalls are projectedagain for the next fiscal year. A key problem has been the rising cost of prescrip-tion drugs. The state saw a 42 percent growth rate in Medicaid drug spending in2002 and has begun to take steps to contain costs. The state will limit the numberof prescriptions and plans to utilize prior authorization and preferred drug listsin hopes of finding savings.

The tension between the state and federal governments has increased in recentmonths.

The federal government’s increased scrutiny of Medicaid accounting practiceshas caused alarm in many states, including South Carolina. The state’s efforts atmaximizing federal matching funds over the past decade have resulted in in-creased scrutiny. Consequently, South Carolina will likely become a testing groundfor the Centers for Medicare and Medicaid Services’ new focus on requiringtighter financial accountability and changing federal policies regarding permis-sible methods of drawing down federal funds.

South Carolina has been hesitant to utilize managed care—either as a potentialcost-saving mechanism or as a method of improving quality of care—despitesome incremental steps in that direction.

Resistance in the provider community has prevented the state legislature frommandating various levels of managed care in Medicaid. However, providers are


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IMPRESSIONS increasingly recognizing the value of the concept of “care management,” and afew strategies, like the MUSC medical home model, are being tested.

Administrative changes to a Medicaid program—such as moving from a“passive” to an “active” eligibility redetermination process—can effectivelylimit enrollment and contain costs.

While the state has not officially cut Medicaid or SCHIP eligibility to date, ad-ministrative changes to the renewal process resulted in a 30 percent decline inenrollment in 2002. It is not clear yet how many families who were disenrolledactually remain eligible for the program. In addition, the state has consideredmoving to a three-month eligibility redetermination process as an additionalcost containment mechanism.

Mental health services receive a growing proportion of South Carolina’s Medic-aid budget and are subject to increased scrutiny from state officials.

The disabled population accounts for 46 percent of overall Medicaid spending,with expenditures for mentally ill persons constituting a significant share of thistotal. Due in part to the scarcity of private-sector mental health providers, mostservices to mentally disabled Medicaid recipients are delivered by the state’smental health agency. In turn, nearly all of the agency’s budget is funded throughthe Medicaid program. State Medicaid officials are beginning to consider waysof improving the management of mental health services as a cost-containmentstrategy. Childrens’ mental health has increasingly emerged as a focus of theseactivities. However, the current structure of the state government and fragmentedinteraction between state agencies have complicated these efforts. At this point itis unclear whether these proposed cost-containment strategies would improveor undermine the quality and accessibility of care available to the mentally ill.

Migrant/Immigration Issues

The Latino population in the low-country region of the state has grown sub-stantially in recent years.

South Carolina’s place near the beginning of the Atlantic coast migrant streamhas made the state a favorite settling place for many families wanting to stay inthe United States permanently.

The migrant farm worker community faces a myriad of barriers to healthyliving and access to care.

In the absence of significant state funding of a safety net beyond Medicaid, fewresources are available to support these workers and their families. Because oftheir undocumented immigration status, most migrants are not eligible for Med-icaid and therefore must rely on free services provided through organizationssuch as the OLM Outreach and Wellness House or pay according to the sliding-fee schedule at community health centers. Typically, migrants are not provided

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IMPRESSIONSsick or vacation leave by their employers, so they must use unscheduled workleave (such as rainy days) to visit health facilities. Finally, problems with trustand with language skills only exacerbate the lack of access to care. Languagebarriers can be particularly troublesome in smaller settings such as individualphysician or dentist offices.

Ongoing demographic changes in the Charleston area are influencing the rangeof health care needs as well as the service delivery structure that has beenestablished to meet those needs.

South Carolina has become a favorite choice for permanent residence of manymigrants who have given up the migrant life for year-round work in landscap-ing, construction, and other lower-wage jobs that support much of the new de-velopment taking place in the island communities outside of Charleston. Many ofthese former migrant workers have sent for their families to join them, increas-ing the need for prenatal and well-child care services.

Silver Linings

South Carolina provides an example of community resourcefulness in identify-ing need and supplying care.

Despite the systemic barriers that exist, a wide array of health centers, hospitals,provider-sponsored volunteer groups, and faith-based organizations have steppedforward in their communities to work toward providing access to primary andpreventive care as well as other social services for low-income individuals andfamilies. In some cases, community organizations have begun to collaborate, asevidenced during the group’s visit to the Sea Island Medical Center and to OurLady of Mercy Outreach Services and Wellness House. In addition, some of theprovider-sponsored efforts have begun to supplement the existing system. Forexample, Tri-County Project Care has placed brochures in many of the state’scommunity health centers, hospitals, and physician’s offices in hopes of reachinguninsured working individuals and enrolling them in the program.

The need to use resources effectively has prompted innovative projects, such asthe Health Resources and Services Administration–sponsored Health Dispari-ties Collaboratives, which have given some health centers a new lens throughwhich to view the treatment and prevention of chronic conditions.

CareSouth Carolina is an example of the success of one of these collaboratives.The organization’s dramatic shift in management style and approach to deliver-ing care has brought about an entirely new practice model to focus on outcomesof care for patients. The new model has resulted in significant decreases in bloodglucose levels of diabetic patients, a more than 80 percent screening and follow-up rate for depression, and near-elimination of trips to the emergency room forasthma symptoms.


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IMPRESSIONS The Medical University of South Carolina’s medical home initiative is connect-ing children with a primary care physician and regular source of medical care,giving families—perhaps for the first time—a real alternative to emergencyrooms.

MUSC’s medical home concept offers both a financially sound approach to pri-mary care and a method of reducing pressure on overburdened emergency de-partments. The capitated payment structure has served as an incentive for avoid-ing the emergency room and for helping manage care. Technological advancessuch as the use of the electronic medical record enable physicians to see morepatients and provide better-coordinated care management.

Recognizing the need for better care management and access to primary andpreventive services, provider-driven and other private initiatives in the Charles-ton area are providing an additional, nongovernmental layer to the safety net.

Providers who are frustrated with treating uninsured patients with preventableconditions have begun to work outside “the system” and are developing innova-tive models for delivering care in the early stages of a disease. Some of themodels are acknowledged as stopgap measures until broader financial access isachieved, and others are viewed as new and improved methods of providinghealth care that is community-supported, rather than government-financed.

CONCERNS FOR THE FUTURE

While the site visit revealed several promising initiatives taking place in SouthCarolina’s health care system, even more apparent were the many barriers thatlow-income families face in trying to access care and the constant challenges thestate and the rest of the safety net must overcome in striving to provide thatcare. Some key concerns for the future include the following:

■ The lack of additional federal assistance in the coming fiscal year, combinedwith the more targeted emphasis on financial accountability in Medicaid, willlikely perpetuate the state budget crisis and require additional Medicaid cost-containment strategies.

■ The impending retirement of Sen. Fritz Hollings (D-SC) will result in a furtherloss of seniority in the U.S. Senate, which may hinder South Carolina’s ability torely on special federal financing and earmarked appropriations to fund healthcare initiatives.

■ Historical and ongoing disparities in education, income, and health status,particularly among racial and ethnic minorities, suggest continued challenges forthe future.

■ Competition rather than collaboration among health care providers and com-munities may hinder their ability to advocate on behalf of patients and them-selves and to maximize resources, develop and share best practices, and connectto hospitals and specialty services to provide comprehensive care.

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AGENDATuesday, February 17, 2004

3:00 pm Check-in at headquarters hotel [Charleston Place, 205 Meeting Street]

3:15 pm Welcome and introductions [Jenkins-King Room, Charleston Place]

3:30 pm THE PALMETTO STATE:HISTORY AND POLITICAL CONTEXT

David Murday, Assistant Director, Health Policy, Center for Health Servicesand Policy Research, Arnold School of Public Health, University of SouthCarolinaPete Bailey, Director, Health and Demographics Division, South CarolinaOffice of Research and Statistics

■ What are the key demographic characteristics of the state?How does South Carolina rank in terms of per capita income,employment, education, and health status?

■ What is the historical context of these demographics? How has the make-up of the state’s population changed over the past 20 years?

■ What are the most prevalent health conditions in the state?What factors contribute to the high incidence of certain conditions?

■ What are the critical programs and state policies that addressthe needs of vulnerable populations in South Carolina?

■ What role do rural hospitals play in making up South Carolina’s safetynet?

■ How has the state budget crisis affected the health care deliverysystem? What are the priorities of the current administration and thestate legislature? Where do the tensions lie?

■ What are the key political dynamics affecting South Carolina’s healthcare system today as compared to 20 years ago?

5:00 pm SOUTH CAROLINA MEDICAID:TOBACCO TAX OR TOUGH DECISIONS?

Robert Kerr, Director, South Carolina Department of Healthand Human Services

■ What are the defining characteristics of South Carolina’s Medicaidprogram and State Children’s Health Insurance Program (SCHIP)?

■ What have been the key successes and challenges of Medicaid andSCHIP in recent years?

■ What has been the impact of the state budget crisis on the Medicaidprogram? How has program enrollment changed over time?

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AGENDA


■ What options are being proposed to bridge the projected shortfall inMedicaid funding in the next fiscal year?

■ What is the likelihood of passage of the much-debated increase in thetobacco tax? If the increase is passed, will the revenue be used to fundMedicaid?

■ What are the elements of the state’s “medical home” initiative?Have the efforts proven effective?

■ What are the governor’s key priorities with respect to health carein the coming year?

6:00 pm Adjourn and break before dinner.

6:30 pm Walk to dinner in downtown Charleston [Hank’s Seafood, Church andHayne Street]

Wednesday, February 18, 2004

8:00 am Breakfast available [Jenkins-King Room, Charleston Place]

8:30 am THE RURAL SAFETY NET

Kathy Schwarting, Executive Director, Low Country Health CareNetwork—Bamberg

David Hayden, Executive Director, Low Country Health Care System,Inc.—AnnandalePete Bowman, Administrator, Carolinas Hospital System—Lake City

■ What are the demographics of South Carolina’s rural areas? How dothey differ from those of Columbia and Charleston?

■ What health conditions pose the greatest challenges for providinghigh-quality care in a relatively isolated area?

■ What are the key financial challenges in operating a rural hospital orhealth center? How do Medicare special payments and other fundingsources assist with financial viability?

■ What role does disproportionate share hospital (DSH) funding playin serving low-income populations?

■ What are the socioeconomic barriers, such as lack of transportation,that inhibit individuals from seeking and receiving needed health care?

9:45am Break

Tuesday, February 17, 2004 (cont.)

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AGENDA

10:00 am Bus departure for Johns Island

10:30 am Tour of Sea Island Medical Center [3627Maybank Highway, Johns Island]

Genevieve Jones, MD, Medical Director, Sea Island Medical Centers, Inc.

Nancy Bracken, Interim Executive Director, Sea Island Medical Center, Inc.

11:00 am Bus departure to Our Lady of Mercy (OLM) Community OutreachServices [1684 Brownswood Road, Johns Island]

11:15 am THE SAFETY NET IN ACTION:HEALTH CENTERS AND HEADACHES

Nancy Bracken, (see title above)

Genevieve Jones, MD, (see title above)

■ What are the demographics of the Sea Island community and how arethey changing?

■ What is the history of the Sea Island Medical Center? How have theownership and management challenges affected the center’s capacityto deliver services?

■ What are the most common events and situations that make up atypical day?

■ What are the cultural barriers that affect access to care?

■ What is the payer mix for patients who come to the health center?How are prescription drugs financed?

■ How have the state budget crisis and resulting changes in the Medicaidprogram affected Sea Island’s ability to meet the needs of low-incomefamilies?

Noon Lunch (provided by Rural Mission, Inc.) and informal discussion withmembers of the Sea Island Medical Center Board of Directors.

1:00 pm Tour of OLM facility

1:30 pm SERVING “THE WHOLE PERSON”:LESSONS IN SOCIAL SERVICE DELIVERY

Sister Mary Joseph Ritter, Executive Director, OLM Community OutreachServices

Jakki Jefferson, Outreach Staff, OLM Community Outreach ServicesAnnette Maranville, Wellness Health Coordinator, OLM Wellness House

John Howard, DMD, Dental Director, OLM Wellness House

Deborah Harnish, Social Worker, OLM Community Outreach Services

Wednesday, February 18, 2004 (cont.)

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AGENDA


■ How did “the Outreach” come to be? How is it financed? What rangeof services does it provide?

■ What are the population dynamics of the Sea Island community? Howdo the changing needs of the population affect OLM’s mission?

■ What are the primary health needs that are being met at the WellnessHouse? What challenges remain?

■ Why has OLM chosen not to become a Medicaid provider or to seekother federal funding?

■ How do the needs of the local migrant population differ from those ofthe rest of the community? What are the key challenges in servingmigrants? What have been some of the successes?

3:00 pm Bus departure for headquarters hotel (with view of migrant camp en route)

3:45 pm Free time in Charleston

6:15 pm Walk to dinner in downtown Charleston [Blossom Café, 171 East Bay Street]

Thursday, February 19, 2004

8:00 am Breakfast available [Jenkins-King Room, Charleston Place]

8:15 am SHIFTING THE PARADIGM: COMMUNITY HEALTH CENTERS (CHCs)AND DISPARITIES COLLABORATIVES

Lathran Woodard, Executive Director, South Carolina Primary Health CareAssociation

Ann Lewis, Chief Executive Officer, CareSouth Carolina, Inc.

■ What role do community health centers play in the make-up of thesafety net in South Carolina?

■ What are they key policy and financing issues facing health centers in thecurrent environment? How has the state fiscal crisis affected CHC policy?

■ How has the Bush administration’s CHC initiative helped or hinderedthe success of the health center movement?

■ What are the goals of the Health Disparities Collaboratives? How musthealth centers restructure their policies and procedures to reducedisparities?

■ What have been the key lessons learned through participation in thecollaboratives? Why are more health centers not involved in this effort?What are the barriers to success?

Wednesday, February 18, 2004 (cont.)

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AGENDA

9:15 am Bus departure for Medical University of South Carolina (MUSC)Children’s Care clinic [2070-A Northbrook Boulevard, North Charleston]

9:45 am MEDICAL HOMES: PATH TO PREVENTION? [MUSC Children’s Care]

Maggie Michael, Director, Center for Advocacy and Development,MUSC Children’s Hospital

Patty Fournier, Practice Manager, MUSC Children’s Care

Matt Davis, MD, Attending Physician, MUSC Children’s Care

■ What is the medical home initiative and what was its genesis?What are the measures of success?

■ What are the advantages and disadvantages of the “one-stop shopping”model?

■ Are medical homes intended to be part of an overall strategy or arethey simply a targeted effort to connect children with primary careproviders?

■ What challenges have emerged as the target population has becomeincreasingly diverse?

■ What is the role of electronic medical records at this site and how dothey help improve the accuracy and efficiency of health care?

11:00 am MEDICAID ON THE FRONT LINES:A TEST OF TENACITY

Helen Thomas, Medicaid Eligibility Administrator, South CarolinaDepartment of Health and Human Services (DHHS)

Jadin Miller, Human Service Specialist, South Carolina DHHS

Nela Gibbons, Deputy Director, Medicaid Eligibility and Beneficiary Services,South Carolina DHHS

■ What are the key steps in the eligibility intake process? What arethe most common reasons for denial of a Medicaid application?

■ What is the average caseload for a Medicaid eligibility worker?

■ How has the state budget crisis affected the Medicaid eligibilityprocess?

■ What effect have the recent program changes had on enrollment andcaseloads?

■ What are the administration’s priorities for Medicaid and SCHIPin the coming year?

11:45 am Bus departure for Charleston Place

Thursday, February 19, 2004 (cont.)

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AGENDA


12:15 pm Checkout and working lunch [Jenkins-King Room, Charleston Place]

12:30 pm WORKING OUTSIDE THE SYSTEM:PROVIDER-DRIVEN INITIATIVES

Hugh Greeley, Chairman, Volunteers in Medicine Institute

Ken Trogdon, Director, Communicare

Casey Fitts, MD, Chairman of the Board and Medical Director, Tri-CountyProject Care

■ What was the genesis of Volunteers in Medicine, Communicare, andTri-County Project Care? How was financing secured? Is the financingsustainable?

■ What have been the key successes of the initiatives?

■ What is the main motivation for working outside of the system toeffectively create another, nongovernmental, layer to the safety net?

■ What role have physicians and other health care providers played increating and operating these programs? How has provider participationchanged over time?

■ What strategies (such as provider credentialing) are in place to ensurequality of care?

■ How do these initiatives fit within the traditional sources of health caredelivery and financing? Has the availability of these initiatives changedthe insurance market (for example, employers’ commitment to offeringhealth coverage)?

■ What are the largest barriers (such as malpractice coverage forvolunteers and access to pharmaceuticals) to expanding these efforts?

1:45 pm Wrap-up discussion

2:00 pm Adjournment and bus departure for Charleston Airport

Thursday, February 19, 2004 (cont.)

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Federal Participants

Jennifer BabcockHealth Insurance SpecialistDivision of State Children’s Health InsuranceFamily and Children’s Health Programs GroupCenter for Medicaid and State OperationsCenters for Medicare and Medicaid ServicesDepartment of Health and Human Services

Evelyne P. BaumruckerAnalyst in Social LegistlationCongressional Research ServiceLibrary of Congress

David BlackLegislative AssistantOffice of Rep. J. Gresham Barrett (R-SC)U.S. House of Representatives

Ed BonapfelLegislative AssistantOffice of Sen. Lindsey Graham (R-SC)U.S. Senate

Andrea CohenHealth and Oversight Counsel (D)Committee on FinanceU.S. Senate

Jeffrey DunlapSenior AdvisorBureau of Primary Health CareHealth Resources and ServicesAdministrationDepartment of Health and Human Services

Ruth ErnstAssistant CounselOffice of the Legislative CounselU.S. Senate

Jennifer FriedmanBudget Analyst (D)Committee on the BudgetU.S. House of Representatives

April GradyAnalyst in Social LegislationDomestic Social Policy DivisionCongressional Research ServiceLibrary of Congress

Suzanne HassettPolicy CoordinatorOffice of the SecretaryDepartment of Health and Human Services

Jean HearneSpecialist in Social LegislationDomestic Social Policy DivisionCongressional Research ServiceLibrary of Congress

Janet HeinrichDirectorHealth Care, Public Health IssuesU.S. General Accounting Office

Lisa HerzSpecialist in Social LegislationDomestic Social Policy DivisionCongressional Research ServiceLibrary of Congress

Lindy HinmanSenior Medicare AnalystHealth DivisionOffice of Management and Budget

Kate MasseySenior Medicaid AnalystHealth DivisionOffice of Management and Budget

Susan McNallyDirectorMedicaid Analysis GroupOffice of LegislationCenters for Medicare and Medicaid ServicesDepartment of Health and Human Services

Dawn MyersLegislative DirectorOffice of Rep. John Spratt (D-SC)U.S. House of Representatives

Lori NealLegislative AssistantOffice of Sen. Blanche Lincoln (D-AR)U.S. Senate


Rhonda RhodesDirectorDivision of Benefits, Coverage, and PaymentFamily and Children’s Health Programs GroupCenter for Medicaid and State OperationsCenters for Medicare and Medicaid ServicesDepartment of Health and Human Services

Federal Participants (cont.)

Vince VentimigliaHealth Policy Director (R)Committee on Health, Education, Labor, and PensionsU.S. Senate

NHPF Staff

Judith D. MooreSenior Fellow

Eileen SalinskyPrincipal Research Associate

Randy DesoniaSenior Research Associate

Jennifer RyanSenior Research Associate

Marcia HowardProgram Associate

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19


Biographical Sketches —Speakers

Walter Phillip (Pete) Bailey is chief of the Health and Demographics Section of theOffice of Research and Statistics of the South Carolina Budget and Control Board. Inaddition to serving as the State Data Center for Census products and analysis, theoffice also maintains data systems that track inpatient hospital discharges, outpatientsurgeries, emergency department visits, home health encounters, health manpower,health education and facilities information, and the South Carolina State EmployeeHealth Insurance Program. Bailey received his BA degree in mathematics at HuntingdonCollege in Montgomery, Alabama, and holds an MPH in biostatistics from the Univer-sity of North Carolina in Chapel Hill.

Pete Bowman is the administrator of the Carolinas Hospital System in Lake City, SouthCarolina. Previously, he was health services administrator for the South Carolina De-partment of Disabilities and Special Needs in the Pee Dee Region. From 1998 to 1999,Bowman was the area manager for Tri-Atlantic Healthcare, Inc., where he was respon-sible for the Tricare managed care contract with the Department of Defense. He spent16 years as a medical service corps officer for the U.S. Navy and spent several yearsworking with Anderson Memorial Hospital, including acting as vice president of thehospital. He received a BS in business administration from The Citadel and an MBA inhealthcare administration from the University of South Carolina.

Nancy Bracken is the interim chief executive officer of Sea Island Medical Centers, Inc.Since 1988, she has worked as an independent contractor providing leadership at a vari-ety of community health centers across the country. Bracken served as interim adminis-trator of the South East Missouri Health Network and consulted at the Little River Medi-cal Center in Little River, South Carolina. She spent most of her career in upstate NewYork as the executive director of Oak Orchard Community Health Center in Brockportand as administrator of the Community Medical Center in Castille. Bracken holds a master’sdegree in public administration from the State University of New York at Brockport.

Matt Davis, MD, is an attending physician at the Medical University of South Carolina(MUSC) Children’s Care.

Casey Fitts, MD, is chairman of the board and medical director of the Tri-County ProjectCare (TCPC) program, which he runs in conjunction with the Charleston County Medi-cal Society. Having dedicated more than a year away from his private medical practiceto develop the program, Fitts plans to return to his general surgery practice of tenyears but will continue in his position with TCPC. Fitts has been a fellow of the Ameri-can College of Surgeons since 1992 and is a member of the American College of Sur-geons, the American Medical Association, the South Carolina Medical Association, theCharleston County Medical Association, and the Medical Society of South Carolina. Hecompleted his medical degree at the Medical University of South Carolina and his gen-eral surgery residency at the University of Mississippi Medical Center. Fitts receivedhis undergraduate degree from Harvard University.

Patty Fournier, RN, is the practice manager for MUSC Children’s Care clinics.


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Biographical Sketches — Speakers (cont.)

Cornelia (Nela) D. Gibbons is the deputy director for Medicaid Eligibility and Benefi-ciary Services and the director of Aging Services at the South Carolina Department ofHealth and Human Services (DHHS). Gibbons served as former Gov. David Beasley’sChief advisor for health and as director of the Division of Health and Human Servicesin the Office of the Governor. Her career includes teaching social work at ColumbiaCollege, serving as the executive director of the South Carolina Chapter of the ArthritisFoundation, director of development for the Center for Cancer Treatment and Re-search at Richland Memorial Hospital, director of the Continuum of Care for Emotion-ally Disturbed Children, executive director of the South Carolina Children’s FosterCare Review Board System, and director of planning and privacy officer for the SouthCarolina Department of Health and Environmental Control. She is also active in volun-teer and civic activities. Gibbons received both her BA in secondary education and hermaster of social work degree from the University of South Carolina.

Hugh Greeley is chairman of the Volunteers In Medicine Institute (VIMI), a not-for-profitorganization dedicated to assisting medical staffs, hospitals, and communities in the de-velopment of clinics serving the uninsured. He is also founder of the Greeley Company, adivision of HCPro, Inc. Before founding the Greeley Company, he held a number ofpositions with the Joint Commission on Accreditation of Healthcare Organizations;InterQual, Inc.; and Kenosha Hospital Medical Center. Greeley was a member of theboard and professional affairs committee of Deaconess–Incarnate Word Health System inSt. Louis, Missouri. He was also one of the founding partners of the Credentialing Insti-tute and a contributing editor to many health care journals. Greeley has served on thefaculties of the Estes Park Institute and the American College of Physician Executives.

Deborah Harnish has been the social worker on staff at Our Lady of Mercy Commu-nity Outreach Services, Inc., since July 2002. After graduating with a BA in sociologyfrom Furman University in Greenville, South Carolina, she spent two years workingwith the Wilkinson Center, providing emergency and long-term services for impover-ished people in Dallas, Texas. Following her time in Dallas, Harnish moved to Colum-bia, South Carolina, where she became the administrative and program associate withthe South Carolina Christian Action Council, a group of 16 Christian denominationsworking on various social justice and public policy issues. Harnish holds a master ofsocial work degree from the University of South Carolina.

David Hayden is the executive director of the Low Country Health Care System, Inc.,which has its main office in Fairfax, South Carolina, and a satellite site in Blackville, SouthCarolina. The Low Country Health Care System is a federally qualified health centerserving Allendale and Barnwell counties and portions of Hampton and Bamberg coun-ties. The health system is the main source of basic primary health care for residents of thisrural and low-income area. The Low Country Health Care System is also the only pro-vider of obstetrical services within this service area. In addition to primary health careservices, Hayden administers a six-county Ryan White Title III program. Previously, Haydenserved six years as the director of the South Carolina Office of Rural Health, following a13-year tenure with the Low Country Area Health Education Consortium.

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John Howard, DMD, is the dental director (and a provider) at the Wellness HouseDental Program at Our Lady of Mercy Community Outreach. In this capacity, Howardprovides guidance and supervision to the Wellness House dental staff, which includesa number of dental students and other volunteer dentists. He also provides dentaleducation to patients and other groups, conducts examinations and screenings, andprovides more urgent treatment. Since 1988, Howard has also been dental director atthe Coastal Center, where he provides dental care for people with developmental dis-abilities. He also serves as a colonel in the U.S. Army Reserve as a member of the 7224th

Medical Support Unit. Howard was in private practice in Mt. Pleasant, South Carolina,from 1984 to 1988. He has a BA from Clemson University and received his doctor ofdental medicine degree from the Medical University of South Carolina.

Jakki Jefferson has been a team member of Our Lady of Mercy Outreach Services, Inc.,since 1989. As a team member at the Outreach, Jefferson facilitates sessions (interagencyagency meetings, parenting classes, quilting classes), teaches jazzercise to the elderlyparticipants in the Nutrition Program, offers a program at the local middle school teachingdiscipline through African drumming and dancing, teaches English as a Second Lan-guage for the local Latino population, assists with homework help for students at theOutreach, and visits clients in their homes. She also serves on committees and boards atthe following: Sea Island Medical Center, School Governance Council, Habitat for Hu-manity, and Wadmalaw Island Improvement Committee. Jefferson worked at St. FrancisXavier hospital in downtown Charleston from 1973 until 1989 in nursing administrationand planning and marketing. Jefferson has maternal lineage on Johns Island as well aspaternal lineage on Wadmalaw Island, enabling her to make a unique contribution tothe Outreach.

Genevieve Jones, MD, is the medical director of Sea Island Medical Centers, Inc., whereshe is responsible for direct patient care as well as day-to-day administration and clinicaloperations. Her work in South Carolina also includes two years as medical director of theFranklin C. Fetter Family Health Center in Charleston and service as an urgent carephysician at Greenville Memorial Hospital and at the Urgent Care Center in Spartanburg.She has also spent several years as a private practice physician in family medicine in Southand North Carolina. Jones has been a board-certified family physician since 1978, is amember of the Charleston County Medical Society, and has staff privileges at RoperHospital and St. Francis Bon Secour Care Alliance Hospital. She received her medicaldegree from Temple University Medical School in Philadelphia and served in residencyat Howard University in Washington, DC.

Robert Kerr has been the director of South Carolina’s DHHS since March 2003. Kerr hasbeen with DHHS since 1985 and served as chief financial officer from 1999 until 2003.Kerr has also served as director of internal audits and compliance for the agency, han-dling a wide range of fraud and abuse issues. A 1981 graduate of the University of SouthCarolina, Kerr is a certified public accountant and certified management accountant.

Ann Lewis has served as the chief executive officer of CareSouth Carolina, Inc., for 23years. Under her leadership, the organization has grown from a small community health


22


center with four employees in Society Hill, South Carolina, to a regional health caresystem with nine primary care sites, 194 employees and a national model of success inthe delivery of health services to those in need in rural communities. CareSouth Caro-lina is the recipient of the South Carolina Primary Health Care Association CommunityHealth Center Achievement Award and has been recognized in a number of nationaltelevision reports as well as in Time magazine. Lewis has served as president of theSouth Carolina Primary Health Care Association, chair of the Great Pee Dee ChampionCommunity, and a board member and founding president of the South Carolina RuralHealth Association. Currently serving as a faculty member for the Institute for HealthcareImprovement and co-chair of the BPHC Finance-Redesign Collaborative, Lewis hasextensive experience in developing and implementing care management services in acommunity health center setting. Lewis is a native of South Carolina. She holds a graduatedegree in health care administration and gerontology from the University of SouthernCalifornia at Los Angeles.

Annette Maranville has been the Wellness Coordinator for Our Lady of Mercy (OLM)Wellness House since its establishment in 2001. She coordinates all programming forthe Wellness House and provides outreach education in the Sea Island community.Maranville began working with OLM as an employee of Bon Secours St. Francis Hospi-tal in 1995. Based on Sea Island, she provided health education and home visits through-out James, Johns, and Wadmalaw Islands. She now operates two programs at WellnessHouse—prenatal care to low-income migrant/immigrant pregnant women and dentalcare for low-income individuals in the Sea Island area. Services are provided free ofcharge. Maranville holds a BSN from Niagra University and a master’s degree in nurs-ing from George Mason University.

Maggie Michael is the director of the Center for Advocacy and Development at MUSCChildren’s Hospital. She is also an officer on the South Carolina Children’s Hospital Col-laborative and co-founder of the MUSC Pediatrics Medical Home Project, which began in1999 and is operating in sites in North Charleston and Monk’s Corner, South Carolina.

David Murday, PhD, is assistant director for health policy at the Center for HealthServices and Policy Research, where he oversees all policy research and evaluationprojects that the center conducts in collaboration with state agencies and professionalorganizations. He also holds an adjunct faculty appointment at the University of SouthCarolina School of Public Health. Before joining the center in 1995, Murday worked forthe South Carolina legislature for 17 years, most recently as director of research for theJoint Legislative Health Care Planning and Oversight Committee. He holds an under-graduate degree from Rutgers University and a doctorate in clinical/community psy-chology from the University of South Carolina.

Sister Mary Joseph Ritter has been the executive director of Our Lady of Mercy Com-munity Outreach Services, Inc., for the past 12 years. She was born in Charleston, SouthCarolina, and became a member of the Sisters of Charity of Our Lady of Mercy in 1960.Ritter taught elementary and secondary school for ten years and served as vice presi-dent of mission effectiveness at St. Francis Hospital. She received a BS in English and

23



education and acquired her master’s in administration of elementary and secondaryschools at Seton Hall University in New Jersey.

Kathy G. Schwarting is the executive director of the Low Country Health Care Net-work, a collaboration of four rural counties in the low country region of South Carolina.The goal of the network is to promote shared services, recruit and retain primary andspecialty providers, and foster partnerships between health care providers and organiza-tions in the low country region. After completing an administrative residency in Marion,South Carolina, with the Marion County Hospital District, Schwarting joined the BambergCounty Hospital and Nursing Center serving as a grant writer, physician recruiter, andliaison between the medical community and the administration. She is a member of theSouth Carolina Rural Health Association and the South Carolina Advisory Council onAging. Schwarting holds a BS degree in Business administration from the University ofSouth Carolina and a master’s in health administration from the Medical University ofSouth Carolina.

Helen Thomas is the regional administrator for Medicaid eligibility for Region 8, over-seeing Charleston, Berkeley, and Dorchester Counties in South Carolina. She supervises86 employees across several eligibility intake and processing offices. Thomas has heldsupervisory positions in the Medicaid program since 1988 and has served in a variety ofpositions, including intake, eligibility processing, and outreach; she also served as a pro-gram manager over both the Temporary Assistance for Needy Families and Supplemen-tal Security Income programs. She holds an undergraduate degree from Winthrop Col-lege and a master’s degree from New Orleans Baptist Theological Seminary.

Ken Trogdon is the executive director and one of the founders of Communicare, anonprofit health care program that coordinates volunteer doctors, dentists, nurse prac-titioners, hospitals, and pharmaceutical companies to provide free medical care forSouth Carolina’s working poor. Communicare has become a national leader in provid-ing prescription medications to the uninsured. Trogdon has also worked in advertisingand has managed marketing for a health care network. In 1998, he launched Smiles for aLifetime, which operates pediatric dental clinics for families with no insurance. In 2000,the U.S. Department of Health and Human Services chose Communicare as one of fivenational “Models That Work” (“innovative, culturally competent models of service de-livery that are effective in increasing access to primary health care and positively im-pacting on disparities in health within their communities”). Since then, Trogdon hasbeen traveling across the country, helping other states establish similar programs.

Lathran Woodard has been the executive director of the South Carolina Primary HealthCare Association since 1991. Woodard also serves as the vice president of the Southeast(eight-state) Health Care Consortium. Previously, Woodard served as the deputy di-rector of maternal health at the South Carolina Department of Health and Environmen-tal Control (DHEC). She was employed by DHEC in different health administrativepositions for 14 years. Woodard was also a 2000 fellow of the Health Resources andServices Administration’s Primary Care Policy Fellowship. She, along with her team,presented a policy to U.S. Department of Health and Human Services Secretary Donna


24


Shalala on screening for depression in women in a primary care setting. Woodard’s con-centration was the screening of women of color and the screening occurring at all levelswithin the primary care system. She has an extensive background in health administra-tion and a degree in business administration from Southern Wesleyan University.

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Biographical Sketches —Federal Participants

Jennifer McGuigan Babcock has been a project officer with the State Children’s HealthInsurance Program (SCHIP) at the Centers for Medicare and Medicaid Services (CMS)since October 2002. Before joining CMS, Babcock was a special assistant to the deputysecretary of health care financing at the Maryland Department of Health and MentalHygiene. She has worked as an associate health policy analyst for the Lewin Group, as anMPH Fellow at the Consumer Health Foundation in Washington, DC, and as a researchassistant at the University of Michigan. Babcock has also served as executive director ofthe Lovelight Foundation, an antipoverty organization in Detroit, Michigan. She holds amaster of public health degree from the University of Michigan, Department of HealthManagement and Policy, and a bachelor of arts in English from Kalamazoo College, inMichigan.

Evelyne P. Baumrucker is an analyst in social legislation in the Domestic Social PolicyDivision of the Congressional Research Service (CRS). In her five-year tenure at CRS,she has worked on Medicaid and SCHIP. Before joining CRS, Baumrucker earned anMA degree from the George Washington University.

David Black is the health legislative assistant to Rep. J. Gresham Barrett (R-SC) in theU.S. House of Representatives. Previously, Black served for three and a half years onthe staff of Sen. Strom Thurmond (R-SC). He is a graduate of the Citadel in Charlestonand a native of Columbia, South Carolina.

Ed Bonapfel has been the health legislative assistant to Sen. Lindsey Graham (R-SC)since March 2003. He began his career on Capitol hill in September 2002 in the office ofRep. John Linder (R-GA). Bonapfel is a 2002 graduate of Davidson College in NorthCarolina and a native of Atlanta.

Andrea Cohen, JD, is the Democratic health and oversight counsel for the Senate FinanceCommittee and has worked for the committee since 2001. She works primarily on Med-icaid and CMS oversight issues, and she played an active role in negotiating the Medicaidand low-income subsidy provisions in the recently passed Medicare prescription drugbill. From 1996 to 2001, Cohen worked as a trial attorney in the Civil Division of the U.S.Department of Justice, representing various federal agencies—including the Departmentof Health and Human Services (DHHS), the Department of State, the Central IntelligenceAgency, and the Department of the Treasury—in civil litigation in U.S. District courts.From July 2000 to January 2001, she served as counsel to Attorney General Janet Reno.Cohen clerked for Chief Judge Myron Thompson in the U.S. District Court, Middle Dis-trict of Alabama, after graduating from Columbia Law School in 1995. She worked as astaff assistant for the Health Subcommittee of the Committee on Ways and Means in theHouse from 1990 to 1992. Cohen is a 1990 graduate of Harvard College.

Jeffrey Dunlap was asked by the administrator of the Health Resources and ServicesAdministration (HRSA) to serve as part of a new management team for the Bureau ofPrimary Health Care (BPHC) and became a senior advisor for the associate administratorin August 2002. He currently leads the newly established Office of Policy, Evaluation, and


26

Biographical Sketches — Federal Participants (cont.)

Data. Previously, Dunlap was the director of BPHC’s Division of State, Community, andPublic Health, where he supervised 41 staff and more than a dozen discrete healthprofessions training–related programs with an overall budget of over $100 million. Healso served as the acting director of the Center for Public Health. Dunlap served assenior advisor in HRSA’s Center for Public Health Practice and as senior advisor to theassociate administrator for field operations; in that position, he spearheaded restruc-turing efforts and served as focal point for the agency’s border health activities. Dunlapbegan his federal service as a presidential management intern. Before joining the gov-ernment, Dunlap served as program director for MAP International and served in thehighlands of Ecuador as a Peace Corps volunteer. Dunlap has a BA in internationalrelations from Syracuse University and an MSPH from the University of North Caro-lina at Chapel Hill.

Ruth Ernst, JD, is an assistant counsel in the Senate Office of Legislative Counsel. Shehas been with the office for over ten years. Ernst concentrates on health and welfareprograms, including Medicaid and SCHIP. She has a JD degree from the University ofChicago.

Jennifer Friedman is a budget analyst with the Democratic staff of the Committee onthe Budget in the U.S. House of Representatives. Friedman’s portfolio includes Medi-care, Medicaid, and public health programs. Prior to joining the Budget Committee, sheworked for five years as a program examiner at the U.S. Office of Management andBudget. In that capacity, Friedman developed policy proposals, reviewed regulationsand waiver proposals, and prepared materials for submission of the president’s budgetfor a range of programs, including Head Start, child care, food stamps, and Medicare.Friedman has a master’s degree in public policy from the University of California atBerkeley and a bachelor of arts from Georgetown University.

April Grady is an analyst in social legislation with CRS. Her work focuses on Medicaidand SCHIP program issues, including enrollment and spending. Before joining CRS,Grady held positions at the Center for Health and Social Policy at the LBJ School ofPublic Affairs and at Mathematica Policy Research. She received a BA from SyracuseUniversity and an MPA from the University of Texas at Austin.

Suzanne Hassett is a policy coordinator in the Office of the Secretary, DHHS, whereshe is responsible for coordinating policy information regarding the Medicaid and SCHIPprograms. Before coming to the secretary’s office two years ago, Hassett worked in theOffice of the Administrator of the Health Care Financing Administration (now CMS),primarily on Medicaid and SCHIP issues. She also spent five years working in the officeof Sen. Jack Reed (D-RI).

Jean Hearne has been a specialist in social legislation with CRS for six years. Her areasof expertise include private health insurance and Medicaid. In 1997, as a contractor toCRS, she worked on the development of the SCHIP legislation. Previously, Hearne wasa program director at the Institute for Health Policy Solutions, where she worked withstates to implement health reforms providing public subsidies for employer-based in-surance. From 1989 to 1997, she served as principal health analyst at the Congressional

27



Budget Office (CBO). While at the CBO, she developed spending models to estimateMedicaid expenditures and worked on the team of analysts estimating the budgetaryimpacts of President Clinton’s Health Security Act.

Janet Heinrich, DrPH, RN, is a director in the Health Care Group in the U.S. GeneralAccounting Office. She oversees all issues dealing with public health. Heinrich previ-ously served as director of the American Academy of Nursing and as the director ofExtramural Programs for the National Institute of Nursing Research at the NationalInstitutes of Health. She has experience as a public health nurse in both urban and ruralareas and has worked in public policy at the local, state, and federal levels.

Lisa Herz, PhD, is a specialist in social legislation in the Domestic Social Policy Divisionof CRS. She has been with CRS for six years, providing policy analysis to Congress onMedicaid issues (eligibility and benefits for children, families, and pregnant women;financing; upper payment limits; and managed care) and SCHIP (all issues). Beforejoining CRS, Herz was an analyst for the Medstat Group, a private health care researchconsulting firm. She has had over 25 years of experience in the health care field andholds a PhD degree from Loyola University of Chicago.

Lindy Hinman is a senior Medicare analyst at the Office of Management and Budget inthe Executive Office of the President. Her responsibilities include providing economic,legislative, and regulatory analyses of issues related to Medicare Part A hospitals, post-acute care facilities, and quality of care. She briefs officials at OMB, the White House,and DHHS on policy recommendations. Hinman holds a bachelor of arts degree fromWashington University in St. Louis and a master’s degree in health services administra-tion from the University of Michigan School of Public Health.

Kate Massey is a senior Medicaid analyst at the Office of Management and Budget inthe Executive Office of the President. Her responsibilities include assisting in the for-mulation of the president’s legislative and regulatory agenda and briefing OMB andWhite House policy officials on current Medicaid issues. Massey has worked on a num-ber of health policy issues while at OMB, including 1115 waiver policy, Medicaid spend-ing trends and issues related to the uninsured. She holds a bachelor of arts degree fromBard College and a master of public affairs from the Lyndon B. Johnson School ofPublic Affairs, University of Texas.

Susan McNally, JD, is director of the Medicaid Analysis Group in CMS’s Office of Leg-islation, where she is responsible for legislation and policy affecting the Medicaid andSCHIP programs as well as initiatives to increase coverage for the uninsured. Withrespect to the recently enacted Medicare Prescription Drug Modernization and Im-provement Act of 2003, McNally has responsibility for issues affecting dual eligibles,low-income subsidies, and the interaction of the new Part D benefit with state Medic-aid programs and state pharmaceutical assistance programs. Before joining CMS, McNallyworked as director of federal affairs at the National Association of Community HealthCenters. She also served as assistant counsel in the Senate Office of Legislative Counsel,attorney advisor in the DHHS Office of the Assistant Secretary for Legislation, associ-ate staff director and general counsel of the 1991 Advisory Council on Social Security


28


(Steelman Commission), and senior health policy advisor to Representative Fred Grandy(R-IA). McNally is a graduate of Barnard College and the Columbia University Schoolof Law.

Dawn Myers, JD, is the legislative director for Rep. John M. Spratt Jr (D-SC). She servedas legislative counsel for Spratt from 1997 until 2003. Myers holds an undergraduatedegree from Vanderbilt University and a JD from Tulane University.

Lori Neal has been a legislative assistant for Sen. Blanche Lincoln (D-AR) since July2003. She is responsible for Medicaid, Temporary Assistance for Needy Families, edu-cation, labor, and other social issues. Neal began her career on Capitol Hill in 2002 as alegislative correspondent for Lincoln. A Lawton, Oklahoma, native, Neal holds abachelor’s degree from the University of Oklahoma and a master of public administra-tion from Columbia University.

Rhonda Rhodes is the director of the Division of Benefits, Coverage, and Payment inthe Family and Children’s Health Programs Group in CMS’s Center for Medicaid andState Operations (CMSO). Rhodes provides leadership and management for policy de-velopment on benefits and coverage issues such as Medicaid’s EPSDT program, mater-nal and child health, and the recently enacted breast and cervical cancer prevention andtreatment option. She is also director of the Noninstitutional Payment Team in CMSO,a national team responsible for oversight of noninstitutional payment policy, includingoutpatient hospital and clinic upper payment limits, school based clinics, federally quali-fied health centers and rural health clinics, and physicians. Previously, Rhodes servedas deputy director of the Division of Integrated Health Systems, where she providedguidance and expertise on Medicaid managed care issues and Section 1115 and Section1915(b) waiver initiatives. She has also served as a legislative aide on Capitol Hill.Rhodes worked in the private sector consultant with a Washington, DC–based firmspecializing in Medicaid and Medicare managed care. She holds a master of sciencedegree in consumer economics from the University of Maryland at College Park.

Vincent Ventimiglia, JD, is the Republican health policy director of the Senate Health,Education, Labor, and Pensions Committee. Previously, he was director of governmentaffairs for Medtronic, Inc., a leading medical technology company. Ventimiglia servedas counsel to the Senate Committee on Labor and Human Resources from 1995 to 1998and staff attorney to the U.S. Sentencing Commission from 1990 to 1994. He has alsoserved as program director at the Capitol Hill Housing Improvement Partnership andas a student attorney at the Harrison Institute for Public Law. Ventimiglia began hiscareer on Capitol Hill in 1985 as a legislative assistant to Sen. Gordon Humphrey (R-NH).He received his BA degree from Yale University and holds a JD from the GeorgetownUniversity Law Center.

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Documents

The Health Care Safety Net in South Carolina - State Coverage